The relationship between physical and mental health: an update from the WPA Working Group on Managing Comorbidity of Mental and Physical Health
Authors: Andrea Fiorillo, Giovanni de Girolamo, Ivona Filipcic Simunovic, Oye Gureje, Mohan Isaac, Cathy Lloyd, Jair Mari, Vikram Patel, Andreas Reif, Elena Starostina, Paul Summergrad, Norman Sartorius
Journal: World Psychiatry (2023)

Compared with the general population, patients suffering from severe mental disorders have a 10 to 25-years shorter life expectancy, which requires urgent action from health care professionals and governments worldwide1, 2. The factors associated with this high mortality rate can be grouped into those related to patients themselves, to psychiatrists, to other medical professionals, and to the health care system at large. Among factors related to the persons with mental disorders, a significant role is played by the presence of comorbid physical illnesses – cardiovascular, respiratory, metabolic, infectious diseases, cancer and others – all of which are frequently given little attention in ordinary psychiatric prac­tice3, 4. Among the reasons for the high rates of physical comorbidity and its contribution to mortality of people with mental disorders is the long-standing separation of psychiatry from other branches of medicine, as well as the lack of attention of several psy­chiatrists to the physical health of their patients5-8. In addition, the collaboration of psy­chiatrists with primary care physicians and other clinicians is often poor, and other health care professionals often have negative attitudes towards people with mental disorders, underestimating the seriousness of their physical complaints. Recently, several international bodies and associations, such as the World Health Organization (WHO), the WPA, the European Psychiatric Association, the UK Royal College of Psychiatrists and the UK Royal College of Practitioners, have taken action to improve the management of physical health of people with severe mental disorders. Among these activities, the revision of educational curricula for health care professionals has been proposed9. In 2017, the WPA created a Scientific Section on Comorbidity, and in January 2021 it established a Working Group on Managing Comorbidity of Mental and Physical Disorders chaired by N. Sartorius. The group includes experts in the field with different backgrounds from high-, medium- and low-income countries10-12. This Working Group has been requested: a) to identify areas of promising work related to comorbidity of mental and physical disorders, and to develop recommendations for WPA's involvement in research, education and service development concerning problems related to that comorbidity; b) to identify individuals and centres interested and willing to participate in WPA's program of research and education related to the comorbidity of mental and physical disorders; c) to liaise with other WPA Working Groups, with a view to ensure that problems of comorbidity are considered in the work of those groups; d) to propose the or­ganization of symposia, workshops and oth­er types of meetings addressing problems related to comorbidity of mental and phys­ical disorders; e) to prepare reviews of evidence and drafts of position papers; f) to build up training programs (see https://www.wpanet.org/wg-on-comorbidity). These tasks are being addressed by: a) the organization of collaborative and inter-sectional symposia and workshops during the World Congresses of Psychiatry, as well as during WPA Thematic and Regional Meetings; b) the development of a range of recorded lectures, live and recorded webinars, and resource documents; c) support to the development of in-country capacity in low-resource settings through the facilitation of high-impact activities and regional collaborations; d) support to the publication of articles in scientific journals as well as chapters in leading textbooks; e) partnership with national and international agencies such as the WHO, the United Nations International Children's Emergency Fund (UNICEF), the US National Institutes of Health (NIH), the Wellcome Trust, and the International Initiative for Disability Leadership, among others, in order to obtain funding in support of good clinical practice, research and training with ­relevance to low-resource countries; f) support to government initiatives, plans and policies as they intersect with the Working Group's remit; g) development of joint initiatives with other WPA Working Groups and Scientific Sections, in the salient areas of public mental health, and child and adolescent mental health; h) providing a selection of evidence-based interventions appropriate for service delivery platforms in low-resource regions; i) creating a list of training and resources available to implement relevant interventions. In March 2022, the Working Group organized a webinar on "Physical illnesses in patients with severe mental disorders: current challenges and practical implications for professionals", attended by more than 500 health care professionals, trainees in psychiatry and medical students, focusing on the complex interplay between physical and mental disorders. During the 22nd World Congress of Psychiatry, the Working Group organized a course on the same topic, which was very well attended. The topic of comorbidity was also discussed in the main plenary session and in a state-of-the-art symposium of the World Congress. The Group has developed and made available on the WPA website educational materials on the comorbidity between depressive disorders and diabetes, depression and cancer, and depression and cardiovascular diseases (www.wpanet.org). The Group is currently engaged in the organization of a series of free WPA webinars on comorbidity between mental disorders and infectious diseases (i.e., HIV, tuberculosis, COVID-19), and has started a collaboration with the International Society of Addiction Medicine, in order to organize educational activities related to the management of addictions and comorbid physical illness in people with severe mental disorders.